Delta variant poses new threat to homeless communities in Oakland

Alameda County offers many places to get free COVID-19 vaccinations if you’re unhoused.

The highly contagious delta variant of the coronavirus is infecting communities that had until now avoided mass outbreaks of COVID-19, including the unhoused population, local health experts said. 

“Delta’s been a real game changer,” said Lucy Kasdin, director of Alameda County’s Health Care for the Homeless program. “We have more positives now at more locations than we’ve had at any time during the pandemic.”

When COVID-19 began to spread throughout Oakland and the county in March 2020, unhoused people and advocates feared the disease would devastate the homeless population, since many people without permanent housing are medically vulnerable, live in close quarters with others, and don’t have anywhere to quarantine. 

But the dreaded outbreaks never came: the 396 total recorded cases among unhoused people in Alameda County during the pandemic reflects a lower positivity rate than that of the general population. Officials attribute the relatively low numbers in large part to the county and city replacing traditional group shelters with hotels and other facilities that offered private rooms, as well as to lower transmission rates in outdoor settings like encampments. 

But that’s changing with delta. “In spaces where we haven’t seen that concern, it’s a new day,” Kasdin said. 

In keeping with federal guidance, and as cases dropped off or disappeared in shelter settings, Health Care for the Homeless had in recent months greatly reduced its “surveillance testing”—regular COVID-19 testing of asymptomatic unhoused individuals, to monitor the spread of the disease. 

“We quickly pivoted back, and now it’s about getting in there and doubling down,” by conducting surveillance testing every week or two at shelters across the county, Kasdin said. The agency can also place people who test positive or are experiencing symptoms in isolation rooms in hotel shelters.

If unhoused people are concerned about contracting COVID-19, the most important step to take to protect oneself is to get vaccinated against the virus, local health officials said. Case rates are much higher among unvaccinated Alameda County residents than they are among the vaccinated population.

The county does not know how many homeless people have been inoculated, since most places that administer the vaccine don’t ask the patient for their address, or whether they’re sheltered or unsheltered, said Seth Gomez, senior pharmacist with Alameda County Health Care for the Homeless. 

“We’ve done what we can to try to get the best approximations of where we are now,” comparing various records against state immunization data, he said. It’s easier to track among fixed populations, like residents of the county’s Project Roomkey hotel shelters—the rate there is 35-50%, Gomez said—or other shelter settings, where the estimated rate of vaccination is 30%.

“That is quite comparable to other homeless programs across the state—we’re right there in the ballpark,” Gomez said. Among unsheltered people sleeping in the streets, the rate is likely lower than in facilities.

Roomkey residents were some of the first unhoused people in the county to get access to the vaccine. In March, Pastor Preston Walker, then a resident of one of the hotel shelters, told The Oaklandside he was eager to get the shot. “I have no hesitation,” he said, noting that several other residents had received theirs already. Walker, who’s now permanently housed in Fremont, is now fully vaccinated.

Others came around to it after initial hesitation.

“At first I was kind of skeptical to get the vaccine,” said John Edwards, a formerly homeless man who recently got housing, at a press conference at the LifeLong Medical Trust Health Center in downtown Oakland this week. “But I knew COVID was a serious disease.” He changed his mind and found that the vaccine “was easy to get.” 

Dr. Jay Reinking, the medical director of the Trust Health Center, said relationship-building is critical when addressing patients’ concerns about the vaccine. LifeLong serves many unhoused people and others who are members of marginalized communities, and Reinking said “listening” to patients and following up on promises are important practices for medical professionals who are guiding people’s personal health decisions. 

“Having other patients be a part of outreach, having staff share their personal experiences with vaccines, and sharing the facts about what’s going on is all we can do to allow people an opportunity to be safe,” he told The Oaklandside. 

Reinking, who’s known as “Dr. Jay” among patients, said many of LifeLong’s patients, and other unhoused people, have experienced severe trauma in their lives, and often have been homeless, unstably housed, or in foster care since childhood. 

“The systems didn’t work for people—housing, health, and other systems of support,” he said. “So folks’ lives are built on being hyper-vigilant” and distrustful of systems and institutions that promise something or tell them what to do.

“So when you bring in something like the vaccine, it works into people’s world paradigm of, ‘What is this you’re invasively putting into me? I’m not sure that I trust that,’” he said.

A group of homeless men who live in tents at Mosswood Park—part of the large encampment that the city cleared this week—expressed that distrust of the vaccine in an interview Monday. They didn’t want to be named because of privacy concerns. 

“I don’t want anything to do with the vaccine,” said one, who said the relative speed with which it was developed raised alarms for him. 

Medical experts say people who are hesitant to get vaccinated often cite a similar reason, but epidemiologists explain that the mRNA method used by both the Pfizer and Moderna shots had been studied and employed for decades previously, and enabled faster development. Many more resources than usual were also dedicated to the development process, which included standard, rigorous trials, according to top epidemiologists.

Another Mosswood resident said he believed his immune system was already tough enough from living on the streets. (However, while the effects of COVID-19 are often worse for immuno-compromised people, the impact of contracting the virus is unpredictable and can have severe consequences for healthy people.) But for other unvaccinated homeless people, their vaccination status is simply a product of lack of access to the shot or time to get it.

“If I was still on the streets, I wouldn’t have made it in for the vaccine,” said Richie Froines, a newly housed resident, at the LifeLong press conference. “I would have pushed it off, forgot all about it. But they made it easy,” he said, referring to the Trust Health Center. He said he’s grateful he’s now better protected against the deadly virus.

Kasdin, the county director, said her staff is visiting encampments and related sites daily to continue promoting the vaccine, as well as offering mobile clinics on a regular schedule where residents can get the shot at many shelter and camp sites. 

“There are ongoing, very assertive efforts to go back to folks, have those conversations, and work through folks’ ambivalence,” she said. “In this moment more than ever.”

In addition to the vaccine, there are other steps that people living outdoors can take to protect themselves against the delta variant, Gomez said.

“You want to make sure to keep your tent and belongings physically distant from others,” he said. Masks are critical too, he said, and he encouraged homeless people to help distribute masks to their neighbors, if possible.

He also issued a word of caution to advocates and others who visit homeless camps to drop off supplies or support residents.

“To protect our community living outside, wear appropriate PPE and social-distance,” Gomez said. “We know there are times when the virus was brought into communities from people who are housed. Just simply being outside isn’t enough anymore.” 

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